Maryland Citizens’ Health Initiative

1. Maryland Citizens’ Health Initiative Report from a quantitative study of voter attitudes on providing quality, affordable health care for everyone in Maryland 202.776.9066 | www.lakeresearch.com | May 2009

2. Survey Methodology • Lake Research Partners designed and administered this survey that was conducted by telephone using professional interviewers from May 11-14, 2009. • The survey reached a total of 700 likely 2010 general election voters in Maryland. Telephone numbers for the sample were drawn randomly from voter file based on vote history. The sample was stratified geographically to reflect the expected turnout of voters. • The data were weighted by age, gender, race, party registration and region. The margin of error for this survey is +/-3.7%. • In interpreting survey results, all sample surveys are subject to possible sampling error. The size of the sampling error depends upon both the total number of respondents in the survey and the percentage distribution of responses to a particular question.

3. Strategic Summary A solid majority of voters support the Maryland Health Care Affordability Act.

4. Key Findings • Nearly two-thirds of voters (64%) support the Maryland Health Care Affordability Act, while just 27% oppose it, and 10% are undecided. In a head-to-head re-ballot with summarized arguments on each side, 62% support the proposal, with strong support increasing from 34% to 44%, and opposition remaining steady at 26%. • HCAA is much more popular than single payer. Marylanders prefer the HCAA proposal to a single payer health care system by a ratio of over 3-to-1 (64% to 18%). Among no demographic group does a plurality of voters prefer the single payer system to the HCAA. • The most popular components of the HCAA concern greater choice and affordability. The most popular component of the proposal is that it would allow individuals who like their current health care coverage to keep it and pay substantially less for it (average score of 80 on a scale of 0-100). The second highest-rated part of the proposal is the establishment of a Maryland Health Insurance Pool to create a marketplace where small businesses and individuals choose their coverage (77). Barring health insurers from denying coverage to those with pre-existing conditions (73) and the state providing catastrophic coverage for everyone (73) are also popular components. • While taxing alcohol and tobacco are the preferred means of funding the proposal, there is also fairly strong support for the 2% payroll tax. Voters approve of the provision to partly fund the proposal with a 75-cent per pack tax increase on cigarettes (average score of 70), and to a slightly lesser extent, with a 10-cent per drink tax on alcohol (68). The 2% payroll tax is slightly more popular when we remind voters that this would be more than made up by savings in health care costs (61 vs. 58).

5. Voters want health care reform now • Marylanders want action now, and say that health care reform in Maryland can’t wait for federal action. By a factor of nearly 2-to-1, voters favor quality affordable health care for all Marylanders even if it means raising taxes (61% to 35%). • And by a factor of more than 2-to-1 (63% to 28%), voters say that it is more urgent than ever in these economic times to accomplish health care reform. A majority (53%) agree more that health care in Maryland is too critical to wait for national reform, with 37% saying national health care reform is coming, so there is no reason to rush reform in Maryland. Maryland voters want real health care reform and they want it now. • Voters respond positively to a statement that those with health care already pay for the medical treatment of the uninsured through higher premiums, so this proposal will lower their premiums. This concept resonates with voters, and it’s a clear way to communicate that covering everyone will have a positive effect on those who are already insured. • Voters also appreciate that this proposal will bring them peace of mind on health care, protect them from insurance companies who deny coverage for those with pre-existing conditions, and that it will invest in prevention.

6. Context Maryland voters support health care reform and do not think Maryland can afford to wait.

7. A majority of Maryland voters say the state’s health care system needs either major reform or a complete overhaul. +55% Does our health care system in Maryland need a complete overhaul, major reform, minor reform or no reform at all ?

8. A broad majority supports health care reform, even if it means raising taxes. Do you favor or oppose providing access to affordable, quality health care for all Marylanders even if it means raising taxes?

9. Voters support health care reform more than 2 to 1 in light of our current economic challenges. A majority of small businesses agree. Urgency of health care reform, given current economic conditions Overall Small Business Owners No: Which of these two statements comes closer to describing your own views? Given the economic challenges facing the state, we cannot take on major health care reform right now OR Given the economic challenges facing the state, it is more urgent than ever to accomplish health care reform.

10. Maryland voters are not interested in waiting for national action on health care reform. Now I would like to read you two statements that could be made about reforming health care in Maryland. Please tell me which one comes closest to your own view. Some say that health care reform is likely to happen at the national level in the near future, so there is no reason to rush to reform health care in Maryland until we know more about the national reform. Others say that it is still important to pursue health care reform in Maryland because if we wait for Congress to act, we could be waiting a good long time, and the issue is too critical to wait.

11. The HCAA Proposal A solid majority of voters support the Maryland Health Care Affordability Act.

12. Nearly two-thirds of voters support the HCAA. Support remains consistent in an informed debate, though intensity of voter support increases significantly.

13. Text of HCAA Proposal

14. Text of HCAA Informed Debate

15. Voters overwhelmingly support HCAA-type reform over single-payer, including nearly two-thirds of small business owners. Which of the following two approaches to providing health care coverage do you prefer? An approach that would guarantee affordable health insurance coverage for every Marylander with a choice of health care plans that cover all necessary medical services, paid for by employers and individuals on a sliding scale OR A single government-financed health insurance plan for all Marylanders financed by tax dollars that would pay private health care providers for a comprehensive set of medical services.

16. Components of the HCAA Proposal Voters want to keep what they have and pay less for it.

17. Voters’ favorite component of HCAA is that it allows them to keep what they have and pay less for it. Barring insurers from denying coverage to those with pre-existing conditions also ranks high. Now, going back to the first health care proposal I just read you, the Maryland Health Care Affordability Act, I’m going to read you some individual components of that proposal. For each one, please rate how favorable you are toward that item on a scale of 0 to 100, where 100 means it is a very convincing reason to support the proposal, and 0 means it is a not at all convincing reason to support the proposal, and you can choose any number in between. If you are not sure, please say so. Here’s the first one. * Asked of half of sample

18. Voters approve of the state’s role in establishing a pool and providing catastrophic coverage for everyone. * Asked of half of sample

19. Both cigarette and alcohol tax increases are popular funding mechanisms. * Asked of half of sample

20. Messaging Voters appreciate the cost advantage of covering everyone.

21. The top testing message is that because those with health care ALREADY pay to treat the uninsured through higher premiums, covering everyone will cut costs and lower premiums for everyone. * Asked of half of sample

22. Peace of mind is a very strong health care value.

23. Protecting those with pre-existing conditions is also a strong message overall. * Asked of half of sample

24. Voters want the reassurance of knowing that they can keep their current coverage if they like it. * Asked of half of sample

25. Gender Men (48%) Women (52%) Party Identification Democrat (58%) Republican (25%) Independent (14%) Survey demographics Demographics of Likely 2010 Maryland Voters • Age • 18-29 (18%) • 30-39 (18%) • 40-49 (21%) • 50-64 (27%) • 65+ (17%) • Education • H.S. or less (38%) • Post H.S. (62%) • College graduate (29%) • Post-graduate (18%) • Marital Status • Married (67%) • Unmarried (32%) • Union • Union HH (14%) • Non-union HH (85%) • Small Business • Owner (13%) • All other (87%) • Region • Rural (17%) • Central (29%) • Baltimore (24%) • Metro DC (30%)

26. Maryland Citizens’ Health Initiative Report from a quantitative study of voter attitudes on providing quality, affordable health care for everyone in Maryland 202.776.9066 | www.lakeresearch.com | May 2009